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. 2021 Apr 13;8(6):ofab187.
doi: 10.1093/ofid/ofab187. eCollection 2021 Jun.

Incidence of Infections and Predictors of Mortality During Checkpoint Inhibitor Immunotherapy in Patients With Advanced Lung Cancer: A Retrospective Cohort Study

Davide Fiore Bavaro  1 , Pamela Pizzutilo  2 , Annamaria Catino  2 , Fabio Signorile  1 , Francesco Pesola  2 , Francesco Di Gennaro  1 , Sandro Cassiano  2 , Ilaria Marech  2 , Vito Lamorgese  2 , Gioacchino Angarano  1 , Laura Monno  1 , Annalisa Saracino  1 , Domenico Galetta  2
Affiliations

Incidence of Infections and Predictors of Mortality During Checkpoint Inhibitor Immunotherapy in Patients With Advanced Lung Cancer: A Retrospective Cohort Study

Davide Fiore Bavaro et al. Open Forum Infect Dis. .

Abstract

Background: Immune checkpoint inhibitors (ICIs) have revolutionized nonsmall cell lung cancer (NSCLC) treatment and significantly increased overall survival of patients. However, the incidence of concurrent infections and their management is still debated.

Methods: From August 2015 to October 2019, all consecutive patients with NSCLC who received nivolumab or pembrolizumab as first- or second-line therapy were retrospectively evaluated. At the time of analysis all patients had died. Clinical characteristics of patients, type of infections, and predictors of mortality were analyzed.

Results: A total of 118 patients were identified: 74 in the nivolumab group and 44 in the pembrolizumab group. At least 1 infection was recorded in 22% of the nivolumab-group versus 27% of the pembrolizumab-group (P = .178). In both groups, the main infection was pneumonia, followed by skin and soft tissue infections, urinary tract infections, and gastroenteritis. Crude mortality for first infection was 10.7%, followed by 25% and 40% for the second and third recurrence, respectively (p for trend = .146). No opportunistic infections were recorded. It is notable that, by Cox-regression model, the independent predictor of mortality was a higher Eastern Cooperative Oncology Group performance status at baseline (P < .001), whereas the multidisciplinary diagnosis and treatment of concurrent infections was associated with a reduced probability of mortality (adjusted hazard ratio = 0.50; 95% confidence interval = 0.30-0.83; P < .001).

Conclusions: In patients with NSCLC treated with ICIs, multidisciplinary management of concurrent infections may reduce the risk of mortality. Further studies to investigate risk factors for infections, as well as appropriate management strategies and preventive measures in this setting, are warranted.

Keywords: advanced lung cancer; bacterial infections; immunocompromised hosts; infectious diseases consultation; pneumonia.

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Figures

Figure 1.
Figure 1.
Time until death according to Eastern Cooperative Oncology Group Performance Status (ECOG) performance status (PS) (a) and infections management (b).
See this image and copyright information in PMC

References

    1. Michot JM, Bigenwald C, Champiat S, et al. . Immune-related adverse events with immune checkpoint blockade: a comprehensive review. Eur J Cancer 2016; 54:139–48. - PubMed
    1. Sznol M, Postow MA, Davies MJ, et al. . Endocrine-related adverse events associated with immune checkpoint blockade and expert insights on their management. Cancer Treat Rev 2017; 58:70–6. - PubMed
    1. Bavaro DF, Fiordelisi D, Angarano G, et al. . Targeted therapies for autoimmune/idiopathic nonmalignant diseases: risk and management of opportunistic infections. Expert Opin Drug Saf 2020; 19:817–42. - PubMed
    1. Fujita K, Kim YH, Kanai O, et al. . Emerging concerns of infectious diseases in lung cancer patients receiving immune checkpoint inhibitor therapy. Respir Med 2019; 146:66–70. - PubMed
    1. Malek A, Khalil M, Hachem R, et al. . Impact of checkpoint inhibitor immunotherapy primarily pembrolizumab on infection risk in patients with advanced lung cancer: a comparative retrospective cohort study. Clin Infect Dis 2020; doi:10.1093/cid/ciaa802. - DOI - PubMed